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| As appeared in the May 2012 issue of Needle Tips |
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| Click here for PDF version |
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| Q: |
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Please review the new recommendations for the use of Tdap in people 65 years and older. |
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| A: |
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| At its February 2012 meeting, the Advisory Committee on Immunization Practices (ACIP) voted to recommend Tdap for adults age 65 years and older. CDC posted the provisional recommendations on its website on March 21 at www.cdc.gov/vaccines/recs/provisional/downloads/Tdap-feb2012.pdf. |
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| Two Tdap vaccines are currently licensed in the United States. They are Boostrix (GSK), approved for use in people age 10 years and older, and Adacel (sanofi pasteur) approved for use in people age 11 through 64 years. |
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| The provisional recommendations state the following: |
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Give a single dose of Tdap to previously unvaccinated adults age 19 years and older. |
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| Give the Tdap dose regardless of the interval since the person last received a tetanus or diphtheria toxoid-containing vaccine. |
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| Give the Tdap dose to adults for whom it is recommended if no record of previous administration exists. |
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| Do not miss an opportunity to give Tdap to people age 65 years and older. Administer the vaccine you have available—either Boostrix or Adacel. When feasible, give Boostrix to adults age 65 and older. However, either vaccine product provides protection and is considered valid for use in people in this age group. |
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| Q: |
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Is there an upper age limit for Tdap administration? For example, should I vaccinate an 85-year-old? |
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| There is no upper age limit for Tdap vaccination. A one-time dose of Tdap is recommended for all adults. |
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| Q: |
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If HPV vaccine is given subcutaneously (SC) instead of intramuscularly (IM), does the dose need to be repeated? |
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| Yes. No data exist on the efficacy or safety of HPV vaccine given by the subcutaneous route. All data on efficacy and duration of protection are based on a 3-dose series given on the approved schedule and administered by the intramuscular route. In the absence of data on subcutaneous administration, CDC and the manufacturers recommend that a dose of HPV vaccine given by any route other than intramuscular be repeated. There is no minimum interval between the invalid (subcutaneous) dose and the repeat dose. |
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| Editor's note: The question above is identical to a question that appeared in
"Ask the Experts" in the February 2012 issue of Needle Tips. The answer, however, is different. The answer given in February generated significant discussion, which led CDC experts to modify the answer. |
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| Q: |
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Which children should receive PPSV vaccine (in addition to PCV13)? At what age should they receive it? What about older high-risk children who never received PCV13—should they get it now? |
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| PPSV is recommended for children with an immunocompromising condition, or functional or anatomic asplenia, and also for immunocompetent children with chronic heart disease, chronic lung disease, diabetes mellitus, cerebrospinal fluid leak, or cochlear implant. Administer |
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| 1 dose of PPSV to children age 2 years and older; administer it at least 8 weeks after the child has received the final dose of PCV. Children with an immunocompromising condition, or functional or anatomic asplenia should receive a second dose of PPSV 5 years after the first PPSV. Older high-risk children who have not yet received a dose of PCV should receive it now. To view a table describing these recommendations in more detail, see IAC's provider-education piece titled
"Recommendations for Pneumococcal Vaccine Use in Children," at www.immunize.org/catg.d/p2016.pdf. |
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Which adults need to receive PPSV prior to age 65 years? |
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| PPSV is recommended for adults age 19 through 64 years who currently smoke cigarettes; reside in nursing homes or long-term care facilities; have chronic lung disease (including chronic obstructive pulmonary disease, emphysema, and asthma); chronic cardiovascular diseases; diabetes mellitus; chronic liver disease (including cirrhosis); alcoholism; cochlear implants; cerebrospinal fluid leaks; immunocompromising conditions; and functional or anatomic asplenia (e.g., sickle cell disease and other hemoglobinopathies, congenital or acquired asplenia, splenic dysfunction, or splenectomy [if elective splenectomy is planned, vaccinate at least 2 weeks before surgery]); asymptomatic or symptomatic HIV (vaccinate as soon as possible after diagnosis). Public health authorities may consider recommending PPSV for American Indians/Alaska Natives who live in areas where the risk for invasive pneumococcal disease is increased. Please see IAC's
'Pneumococcal Polysaccharide Vaccine: CDC answers your questions” at www.immunize.org/catg.d/p2015.pdf. |
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| Editor's note: The next Q&A explains which adults need a second dose of PPSV. |
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Which adults should receive a second dose of PPSV? |
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One-time revaccination 5 years
after the first dose is
recommended for people age 19
through 64 years who have
functional or anatomic
asplenia (including persons
with sickle cell disease or
splenectomy patients); chronic
renal failure (including
dialysis patients) or
nephrotic syndrome; are
immunocompromised, including
those with HIV infection,
leukemia, lymphoma, Hodgkin's
disease, multiple myeloma,
generalized malignancy; are
receiving immunosuppressive
therapy (including long-term
systemic corticosteroids or
radiation therapy); or who
have received an organ or bone
marrow transplant. |
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Adults who receive their first
PPSV at or after age 65 years
should receive only a single
dose, regardless of their
health status. Please see
IAC's "Pneumococcal
Polysaccharide Vaccine: CDC
answers your questions" at
www.immunize.org/catg.d/p2015.pdf. |
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PCV13 is now licensed for use in
adults, but I don't see anything about
it in the 2012 adult immunization
schedule. How should it be used? |
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FDA
licensed PCV13 (Prevnar13;
Pfizer) for adults age 50 years
and older in December 2011. At
its February 2012 meeting, ACIP
reviewed the evidence for the
use of PCV13 in adults but did
not vote on recommendations for
its use in adults. As always,
physicians can use their
clinical judgment and use
FDA-licensed vaccines if they
would like to do so. |
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What are the minimum intervals for
giving the 3-dose series of Twinrix
(hepatitis A-hepatitis B vaccine; GSK)? |
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Minimum intervals for Twinrix
are 4 weeks between dose #1 and
dose #2, and 5 months between
dose #2 and dose #3. |
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| Q: |
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PCV13 is now licensed for use in adults, but I don't see anything about it in the 2012 adult immunization schedule. How should it be used? |
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| FDA licensed PCV13 (Prevnar13; Pfizer) for adults age 50 years and older in December 2011. At its February 2012 meeting, ACIP reviewed the evidence for the use of PCV13 in adults but did not vote on recommendations for its use in adults. As always, physicians can use their clinical judgment and use FDA-licensed vaccines if they would like to do so. |
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What are the minimum intervals for Twinrix (hepatitis A-hepatitis B vaccine; GSK)? |
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| Minimum intervals for Twinrix are 4 weeks between dose #1 and dose #2, and 5 months between dose #2 and dose #3. |
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When
reconstituting a vaccine with the
manufacturer-supplied diluent, should
the clinic nurse administer exactly
0.5 mL and then discard the rest? |
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No.
The nurse should administer the
entire volume supplied. The
package inserts include this
information. |
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Should we
fill out a report with the Vaccine
Adverse Event Reporting System (VAERS)
if a patient faints after getting a
vaccination, even if no injury or
complication resulted? |
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Yes.
VAERS looks for trends, so such
information is helpful. To find
out about VAERS and the kinds of
events you should report to the
system, visit vaers.hhs.gov/index. |
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If a new
version of a VIS becomes available, is
it legal for us to use up the outdated
VISs or do we have to discard them and
provide the most up-to-date version? |
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When
a new or updated VIS is
released, CDC posts information
on its website that indicates if
healthcare providers can use up
their stock of the old version
of the VIS or should discard the
old version and begin using the
new VIS right away. The answer
generally depends on how
significantly the VIS was
changed. You can tell what has
been changed recently by going
to the CDC website at
www.cdc.gov/vaccines/pubs/vis/vis-news.htm. |
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To
determine whether you need to
use the new one versus the old,
you can have CDC email you an
update by subscribing to CDC's
free email subscription service
at
www.cdc.gov/emailupdates.
After you've signed up, you'll
be taken to a page with lots of
options. Once there, check the
Vaccine Information Statements
box under the section titled
"Vaccines & Immunizations." |
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A
10-year-old girl came to our
immunization clinic, and the nurse
noted crusted lesions on her arms and
legs. The parent said the child had
had chickenpox a week earlier. The
girl was not ill, so we vaccinated
her. But now I am wondering if her
recent case of chickenpox might
interfere with her immune response to
vaccines. |
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Do
not be concerned that the girl's
recent case of chickenpox will
interfere with her immune
response. Previous history of
chickenpox disease, even recent
disease, will not interfere with
the immune response to different
vaccines. To review the true
contraindications and
precautions to vaccination,
consult IAC's "Guide to
Contraindications and
Precautions to Commonly Used
Vaccines" at
www.immunize.org/catg.d/p3072a.pdf.
Another helpful resource is
ACIP's General Recommendations
on Immunization. It contains a
useful table titled "Conditions
commonly misperceived as
contraindications to
vaccination." The table is
available at
www.cdc.gov/vaccines/recs/vac-admin/contraindications-misconceptions.htm. |
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| Q: |
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A child
wiggled when we were injecting a dose
of vaccine, and approximately half the
dose was lost. Should we revaccinate
the child? If so, when? |
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When
injectable vaccine volume is
lost (patient moves, syringe
leaks), it may be difficult to
judge how much vaccine the
patient actually received. In
general, you should treat this
as a nonstandard injectable dose
and should not count it. If it
was an inactivated vaccine, you
should re-immunize the person as
soon as possible. If it was a
live vaccine, you can give
another dose if you detect the
error on the same clinic day;
otherwise you should wait 28
days to give the next dose.
However, if part of a dose of an
oral vaccine (rotavirus) was
spit out, count the dose and do
not administer a second dose. |
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Should a
healthcare worker who has just
received a dose of a live virus
vaccine (varicella, MMR, LAIV, yellow
fever) stay away from work for a
certain number of days? |
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No. Healthcare workers should
not refrain from working after
receiving live virus vaccines or
any other vaccine. |
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| Click here for PDF version |
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Immunization Action Coalition • 1573 Selby Ave • St. Paul, MN 55104 |
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tel 651-647-9009 • fax 651-647-9131 |
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This website is supported in part by a cooperative agreement from the National Center for Immunization and Respiratory Diseases (Grant No. 5U38IP000290) at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA. The website content is the sole responsibility of IAC and does not necessarily represent the official views of CDC. |
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